- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $4,570.88 / $7,079.46
| Facility | | $794.33 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | 50 | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $575.44 / $2,089.30
| Professional | | $331.13 | $575.44 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,905.46 / $7,079.46
| Facility | | $977.24 | $1,905.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,202.26 / $1,548.82
| Professional | | $977.24 | $1,202.26 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,888.44 / $7,762.47
| Facility | | $3,467.37 | $5,888.44 | $7,762.47 |